Tranexamic acid in proximal femoral megaprosthetic reconstruction for metastatic bone disease

This retrospective comparative study evaluated the effect of tranexamic acid (TXA) on perioperative transfusion requirements and clinically documented thromboembolic events in patients undergoing proximal femoral tumor resection and megaprosthetic reconstruction for metastatic bone disease. A total of 32 patients who underwent proximal femoral tumor resection and megaprosthetic reconstruction between 2019 and 2026 were included. The patients were divided according to perioperative TXA administration (TXA group, n = 15; control group, n = 17). TXA was administered intravenously at 10 to 15 mg/kg prior to skin incision. Primary outcomes included transfusion requirements and the number of transfused erythrocyte units. The secondary outcomes included perioperative hemoglobin change, length of hospital stay, postoperative complications, and mortality. Perioperative blood transfusion was required in 60.0% and 82.4% of the patients in the TXA and control groups, respectively (P = .243). The transfusion requirement was numerically lower in the TXA group, corresponding to an absolute difference of 22.4 percentage points (relative risk, 0.73). The mean number of transfused units was similar between groups (1.27 ± 1.22 vs 1.35 ± 0.99, P = .829). Hospital stay was numerically shorter in the TXA group (9.53 ± 4.73 vs 13.94 ± 10.52 days, P = .202). No clinically documented symptomatic thromboembolic events were observed in either group of patients. In this small retrospective cohort, TXA use was associated with a numerically lower perioperative transfusion requirement, although the difference was not statistically significant. These findings should be considered exploratory and hypothesis-generating and require confirmation in larger, adequately powered prospective studies.